Surg Radiol Anat
DOI 10.1007/s00276-016-1630-0
ANATOMIC VARIATIONS
Unilateral hypoplasia with contralateral hypertrophy of anterior
belly of digastric muscle: a case report
Martin Ochoa-Escudero1 Amy F. Juliano2
Received: 13 July 2015 / Accepted: 18 January 2016
Springer-Verlag France 2016
Abstract Anomalies of the anterior belly of the digastric
muscle (DM) are uncommon. We present a case of hypo-
plasia of the anterior belly of the left DM with hypertrophy
of the anterior belly of the contralateral DM. The impor-
tance of recognizing this finding is to differentiate hypo-
plasia of the anterior belly of the DM from denervation
atrophy, and not to confuse contralateral hypertrophy with
a submental mass or lymphadenopathy. In denervation
atrophy of the anterior belly of the DM, associated atrophy
of the ipsilateral mylohyoid muscle is present. Hypertrophy
of the anterior belly of the contralateral DM can be dif-
ferentiated from a submental mass or lymphadenopathy by
recognizing its isodensity on computed tomography and
isointensity on magnetic resonance imaging to other mus-
cles, without abnormal contrast enhancement.
Keywords Anterior belly
Digastric muscle

Hypoplasia
Hypertrophy
Introduction
Anomalies of the anterior belly of the digastric muscle
(DM) are uncommon. The importance of understanding
these anomalies is to avoid confusing them with pathology.
We present a case of hypoplasia of the anterior belly of the
left DM with hypertrophy of the anterior belly of the
contralateral DM.
& Martin Ochoa-Escudero
martin127d@gmail.com
1
Department of Radiology, Neuroradiology Section, Hospital
Pablo Tobon Uribe, Calle 78B # 69-240, Medelln, Colombia
2
Massachusetts Eye and Ear Infirmary and Harvard Medical
School, Boston, MA, USA
Case report
A 48-year-old male with a history of treated squamous cell
carcinoma of the lower lip presented in clinic for outpatient
follow-up. On physical examination, a right submental mass
was palpated. Because of the suspicion for potential meta-
static lymphadenopathy, a contrast-enhanced computed
tomography (CT) scan of the neck was performed to assess the
submental region, as well as to evaluate for lymphadenopathy
elsewhere in the neck. The CT images showed almost com-
plete absence of the anterior belly of the left DM with only a
small amount of muscular tissue in its expected location, and
normal appearance of the mylohyoid muscle, consistent with
anterior belly hypoplasia. The anterior belly of the right DM
was present in its normal location but exhibited enlargement,
suggestive of hypertrophy (Fig. 1). The posterior bellies of
both digastric muscles were present and were normal in size
and location. It was noted that the patient did not have a
history of surgery involving the submental area.
Discussion
The DM consists of two muscle bellies which are con-
nected by an intermediate rounded tendon. The tendon is
held in place via a fibrous loop to the hyoid bone [10]. The
anterior belly originates from a depression located on the
posterior surface of the symphysis menti of the mandible,
termed the digastric fossa. The posterior belly originates
from the inferomedial surface of the mastoid process of the
temporal bone in a groove termed the mastoid notch,
digastric notch, or digastric groove. Both the anterior and
posterior bellies insert on the fibrous loop to the lesser
cornu of the hyoid bone [10]. The anterior and posterior
bellies have different embryologic derivations, and are
123

Fig. 1 Axial (a) and coronal (b) contrast-enhanced CT images show
almost complete absence of the anterior belly of the left DM with just
a small amount of muscular tissue in its expected location (small
supplied by different cranial nerves: the anterior belly is
supplied by the mylohyoid nerve, a branch of cranial nerve
V3; the posterior belly is supplied by the digastric branch
of cranial nerve VII [10].
Anomalies of the anterior belly of the DM are uncom-
mon. There are various types of anomalies [6, 7]. Duplicated
or accessory muscle bellies or muscle bundles are the most
common type [5, 9]. In our case, there is hypoplasia of the
anterior belly of the left DM with hypertrophy of the con-
tralateral anterior belly. This anomaly has been described in
patients with hemifacial microsomia [4]. The importance of
recognizing this finding includes being able to differentiate
anterior belly hypoplasia from denervation atrophy associ-
ated with injury to the mylohyoid nerve [2], and not con-
fusing hypertrophy of the contralateral anterior belly with
contralateral submental pathology such as a mass or lym-
phadenopathy [1].
In denervation atrophy of the anterior belly of the DM,
associated atrophy of the ipsilateral mylohyoid muscle is
present. This is due to the common innervation of both the
mylohyoid muscle and the anterior belly of the DM by the
mylohyoid nerve, a branch of the inferior alveolar nerve,
from the mandibular division of the fifth cranial nerve [8].
Hypertrophy of the anterior belly of the contralateral DM
can be differentiated from a submental mass or lym-
phadenopathy by recognizing its isodensity on CT and
isointensity on magnetic resonance imaging (MRI) to other
muscles, absence of abnormal enhancement, and hypoplas-
tic appearance of its counterpart on the other side [3].
Conclusion
Hypoplasia of the anterior belly of the DM is an uncom-
mon anomaly and should be differentiated from denerva-
tion atrophy. Hypertrophy of the anterior belly of the
123
Surg Radiol Anat
arrow in a). Additionally, the anterior belly of the right DM is
enlarged (long arrow)
contralateral DM should not be mistaken for submental
pathology such as a mass or lymphadenopathy.
Compliance with ethical standards
Conflict of interest The authors certify that there is no actual or
potential conflict of interest in relation to this article.
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